Provider Demographics
NPI:1932444676
Name:BLACKVILLE HEALTH INVESTORS INC
Entity Type:Organization
Organization Name:BLACKVILLE HEALTH INVESTORS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:MCHUGH
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:803-939-8489
Mailing Address - Street 1:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:GASTON
Mailing Address - State:SC
Mailing Address - Zip Code:29053-0310
Mailing Address - Country:US
Mailing Address - Phone:803-939-8489
Mailing Address - Fax:803-939-8489
Practice Address - Street 1:19354 SOLOMON BLATT AVE N
Practice Address - Street 2:
Practice Address - City:BLACKVILLE
Practice Address - State:SC
Practice Address - Zip Code:29817-2304
Practice Address - Country:US
Practice Address - Phone:803-284-3372
Practice Address - Fax:803-284-3372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-06
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
6729260001Medicare NSC